Introduction

The objective of this study was to investigate the value of low-dose whole pancreatic computed tomography (CT) perfusion integrated with individualized dual-energy CT (DECT) scanning in the diagnosis of pancreatic adenocarcinoma.

Results

There were significant difference on blood flow as well as blood volume between pancreatic adenocarcinoma and the non-tumourous pancreatic parenchyma (P < 0.05), whereas no difference on permeability (P > 0.05). CNRs of pancreas-to-tumour in individualized pancreatic phase were significantly higher than those in venous phase (P < 0.05), and CNRs of optimal monoenergetic images were higher than those on weighted-average 120 kVp images (P < 0.05) in both phase. Total effective radiation dose of CT examination was around 9.32–13.75 mSv.

Conclusions

Low-dose whole pancreatic CT perfusion can provide functional information, and the individualized pancreatic phase DECT scan is the optimal method for detecting pancreatic adenocarcinomas. The integration of the two techniques has great value in clinical application.

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Introduction
The objective of this study was to investigate the value of low-dose whole pancreatic computed tomography (CT) perfusion integrated with individualized dual-energy CT (DECT) scanning in the diagnosis of pancreatic adenocarcinoma.
Methods
Twenty patients with pancreatic adenocarcinoma underwent pancreatic CT perfusion as well as individualized dual-phase DECT pancreatic scans. Perfusion characteristics of non-tumourous pancreatic parenchyma and pancreatic adenocarcinoma were analysed. Weighted-average 120 kVp images and the optimal monoenergetic images in dual phase were reconstructed and the contrast noise ratio (CNR) of pancreas-to-tumour were compared.
Results
There were significant difference on blood flow as well as blood volume between pancreatic adenocarcinoma and the non-tumourous pancreatic parenchyma (P < 0.05), whereas no difference on permeability (P > 0.05). CNRs of pancreas-to-tumour in individualized pancreatic phase were significantly higher than those in venous phase (P < 0.05), and CNRs of optimal monoenergetic images were higher than those on weighted-average 120 kVp images (P < 0.05) in both phase. Total effective radiation dose of CT examination was around 9.32–13.75 mSv.
Conclusions
Low-dose whole pancreatic CT perfusion can provide functional information, and the individualized pancreatic phase DECT scan is the optimal method for detecting pancreatic adenocarcinomas. The integration of the two techniques has great value in clinical application.
Comparison of CT-based volumetric dosimetry with traditional prescription points in the treatment of cervical cancer with PDR brachytherapyhttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12341Comparison of CT-based volumetric dosimetry with traditional prescription points in the treatment of cervical cancer with PDR brachytherapyNicola Lowrey, Sanna Nilsson, Zoe Moutrie, Philip Chan, Robyn Cheuk2015-07-29T05:28:46.392657-05:00doi:10.1111/1754-9485.12341John Wiley & Sons, Inc.10.1111/1754-9485.12341http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12341Radiation Oncology—Original Articlen/an/aAbstract

Introduction

The traditional use of two-dimensional geometric prescription points in intracavitary brachytherapy planning for locally advanced cervical cancer is increasingly being replaced by three-dimensional (3D) planning. This study aimed to directly compare the two planning methods to validate that CT planning provides superior dosimetry for both tumour and organs at risk (OARs) in our department.

Methods

The CT planning data of 10 patients with locally advanced cervical cancer was audited. For each CT dataset, two new brachytherapy plans were created, comparing the dosimetry of conventional American Brachytherapy Society points and 3D-optimised volumes created for the high-risk clinical target volume (HR CTV) and OARs. Total biologically equivalent doses for these structures were calculated using the modified EQD2 formula and comparative dose-volume histogram (DVH) analysis performed.

Results

DVH analysis revealed that for the 3D-optimised plans, the prescription aim of D90 ≥ 100% was achieved for the HR CTV in all 10 patients. However, when prescribing to point A, only 50% of the plans achieved the minimum required dose to the HR CTV. Rectal and bladder dose constraints were met for all 3D-optimised plans but exceeded in two and one of the conventional plans, respectively.

Conclusions

This study confirms that the regionally relevant practice of CT-based 3D-optimised planning results in improved tumour dose coverage compared with traditional points-based planning methods and also improves dose to the rectum and bladder.

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Introduction
The traditional use of two-dimensional geometric prescription points in intracavitary brachytherapy planning for locally advanced cervical cancer is increasingly being replaced by three-dimensional (3D) planning. This study aimed to directly compare the two planning methods to validate that CT planning provides superior dosimetry for both tumour and organs at risk (OARs) in our department.
Methods
The CT planning data of 10 patients with locally advanced cervical cancer was audited. For each CT dataset, two new brachytherapy plans were created, comparing the dosimetry of conventional American Brachytherapy Society points and 3D-optimised volumes created for the high-risk clinical target volume (HR CTV) and OARs. Total biologically equivalent doses for these structures were calculated using the modified EQD2 formula and comparative dose-volume histogram (DVH) analysis performed.
Results
DVH analysis revealed that for the 3D-optimised plans, the prescription aim of D90 ≥ 100% was achieved for the HR CTV in all 10 patients. However, when prescribing to point A, only 50% of the plans achieved the minimum required dose to the HR CTV. Rectal and bladder dose constraints were met for all 3D-optimised plans but exceeded in two and one of the conventional plans, respectively.
Conclusions
This study confirms that the regionally relevant practice of CT-based 3D-optimised planning results in improved tumour dose coverage compared with traditional points-based planning methods and also improves dose to the rectum and bladder.
Computed tomography overexposure as a consequence of extended scan lengthhttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12339Computed tomography overexposure as a consequence of extended scan lengthMohamed Khaldoun Badawy, Michael Galea, Kam Shan Mong, Paul U2015-07-14T09:01:05.678833-05:00doi:10.1111/1754-9485.12339John Wiley & Sons, Inc.10.1111/1754-9485.12339http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12339Medical Imaging—Original Articlen/an/aAbstract

Introduction

This study aimed to raise awareness around the increased effective dose as scan length chosen is increased from standard protocol

Results

The results of this study show that for scans with a high computed tomography dose index (CTDI)vol the patient could be exposed to an extra 1 mSv within 6 cm of overscan. Protocols that investigated large scan areas may not see a significant relative dose reduction because of the use of a lower CTDIvol; however, radiation exposure should be kept as low as reasonably achievable.

Conclusion

There is significant dose optimisation potential when strictly adhering to appropriate scan lengths within each imaging protocol wherever possible.

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Introduction
This study aimed to raise awareness around the increased effective dose as scan length chosen is increased from standard protocol
Methods
The Monte Carlo-based software CT-Expo (G. Stamm (Medizinische Hochschule Hannover, Hannover, Germany) and H.D. Nagel (SASCRAD, Buchholz, Germany)) was used to simulate the effective dose increase as the scanned region of the standard protocol increased.
Results
The results of this study show that for scans with a high computed tomography dose index (CTDI)vol the patient could be exposed to an extra 1 mSv within 6 cm of overscan. Protocols that investigated large scan areas may not see a significant relative dose reduction because of the use of a lower CTDIvol; however, radiation exposure should be kept as low as reasonably achievable.
Conclusion
There is significant dose optimisation potential when strictly adhering to appropriate scan lengths within each imaging protocol wherever possible.
3T MRI evaluation of large nerve perineural spread of head and neck cancershttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.123383T MRI evaluation of large nerve perineural spread of head and neck cancersJustin Baulch, Mitesh Gandhi, Jennifer Sommerville, Ben Panizza2015-07-14T07:31:55.994046-05:00doi:10.1111/1754-9485.12338John Wiley & Sons, Inc.10.1111/1754-9485.12338http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12338Medical Imaging—Original Articlen/an/aAbstract

Introduction

Accurate definition of the presence and extent of large nerve perineural spread (PNS) is a vital component in planning appropriate surgery and radiotherapy for head and neck cancers. Our research aimed to define the sensitivity and specificity of 3T MRI in detecting the presence and extent of large nerve PNS, compared with histologic evaluation.

Methods

Retrospective review of surgically proven cases of large nerve PNS in patients with preoperative 3T MRI performed as high resolution neurogram.

Results

3T MRI had a sensitivity of 95% and a specificity of 84%, detecting PNS in 36 of 38 nerves and correctly identifying uninvolved nerves in 16 of 19 cases. It correctly identified the zonal extent of spread in 32 of 36 cases (89%), underestimating the extent in three cases and overestimating the extent in one case.

Conclusion

Targeted 3T MRI is highly accurate in defining the presence and extent of large nerve PNS in head and neck cancers. However, there is still a tendency to undercall the zonal extent due to microscopic, radiologically occult involvement. Superficial large nerve involvement also remains a difficult area of detection for radiologists and should be included as a ‘check area’ for review. Further research is required to define the role radiation-induced neuritis plays in the presence of false-positive PNS on MRI.

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Introduction
Accurate definition of the presence and extent of large nerve perineural spread (PNS) is a vital component in planning appropriate surgery and radiotherapy for head and neck cancers. Our research aimed to define the sensitivity and specificity of 3T MRI in detecting the presence and extent of large nerve PNS, compared with histologic evaluation.
Methods
Retrospective review of surgically proven cases of large nerve PNS in patients with preoperative 3T MRI performed as high resolution neurogram.
Results
3T MRI had a sensitivity of 95% and a specificity of 84%, detecting PNS in 36 of 38 nerves and correctly identifying uninvolved nerves in 16 of 19 cases. It correctly identified the zonal extent of spread in 32 of 36 cases (89%), underestimating the extent in three cases and overestimating the extent in one case.
Conclusion
Targeted 3T MRI is highly accurate in defining the presence and extent of large nerve PNS in head and neck cancers. However, there is still a tendency to undercall the zonal extent due to microscopic, radiologically occult involvement. Superficial large nerve involvement also remains a difficult area of detection for radiologists and should be included as a ‘check area’ for review. Further research is required to define the role radiation-induced neuritis plays in the presence of false-positive PNS on MRI.
Radiation Oncology Training Program Curriculum developments in Australia and New Zealand: Design, implementation and evaluation – What next?http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12337Radiation Oncology Training Program Curriculum developments in Australia and New Zealand: Design, implementation and evaluation – What next?Sandra Turner, Matthew Seel, Martin Berry2015-06-29T21:28:36.96771-05:00doi:10.1111/1754-9485.12337John Wiley & Sons, Inc.10.1111/1754-9485.12337http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12337Radiation Oncology—Original Articlen/an/aAbstract

Introduction

The Australian and New Zealand Radiation Oncology Training Program has undergone major changes to align with pedagogical principles and best-evidence practice. The curriculum was designed around the Canadian Medical Education Directives for Specialists framework and involved structural programme changes and new in-training assessment. This paper summarises the work of programme design and implementation and presents key findings from an evaluation of the revised programme.

Methods

An independent team conducted the evaluation during the last year of the first 5-year curriculum cycle. Opinions were sought from trainees, supervisors and directors of training (DoTs) through online surveys, focused interviews and group consultations. One hundred nineteen participated in surveys; 211 participated in consultations. All training networks were represented.

Results

The new curriculum was viewed favourably by most participants with over 90% responding that it ‘provided direction in attaining competencies’. Most (87/107; 81%) said it ‘promotes regular, productive interaction between trainees and supervisors’. Adequacy of feedback to trainees was rated as only ‘average’ by trainees/trainers in one-third of cases. Consultations revealed this was more common where trainers were less familiar with curriculum tools. Half of DoTs/supervisors felt better supported. Nearly two-third of all responders (58/92; 63%) stated that clinical service requirements could be met during training; 17/92 (18.5%) felt otherwise. When asked about ‘work-readiness’, 59/90 (66%) respondents, including trainees, felt this was improved.

Conclusion

Findings suggest that the ‘new’ curriculum has achieved many of its aims, and implementation has largely been successful. Outcomes focus future work on better supporting trainers in using curriculum tools and providing useful feedback to trainees.

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Introduction
The Australian and New Zealand Radiation Oncology Training Program has undergone major changes to align with pedagogical principles and best-evidence practice. The curriculum was designed around the Canadian Medical Education Directives for Specialists framework and involved structural programme changes and new in-training assessment. This paper summarises the work of programme design and implementation and presents key findings from an evaluation of the revised programme.
Methods
An independent team conducted the evaluation during the last year of the first 5-year curriculum cycle. Opinions were sought from trainees, supervisors and directors of training (DoTs) through online surveys, focused interviews and group consultations. One hundred nineteen participated in surveys; 211 participated in consultations. All training networks were represented.
Results
The new curriculum was viewed favourably by most participants with over 90% responding that it ‘provided direction in attaining competencies’. Most (87/107; 81%) said it ‘promotes regular, productive interaction between trainees and supervisors’. Adequacy of feedback to trainees was rated as only ‘average’ by trainees/trainers in one-third of cases. Consultations revealed this was more common where trainers were less familiar with curriculum tools. Half of DoTs/supervisors felt better supported. Nearly two-third of all responders (58/92; 63%) stated that clinical service requirements could be met during training; 17/92 (18.5%) felt otherwise. When asked about ‘work-readiness’, 59/90 (66%) respondents, including trainees, felt this was improved.
Conclusion
Findings suggest that the ‘new’ curriculum has achieved many of its aims, and implementation has largely been successful. Outcomes focus future work on better supporting trainers in using curriculum tools and providing useful feedback to trainees.
Guidelines for safe practice of stereotactic body (ablative) radiation therapyhttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12336Guidelines for safe practice of stereotactic body (ablative) radiation therapyMatthew Foote, Michael Bailey, Leigh Smith, Shankar Siva, Fiona Hegi-Johnson, Anna Seeley, Tamara Barry, Jeremy Booth, David Ball, David Thwaites2015-06-29T21:28:20.51409-05:00doi:10.1111/1754-9485.12336John Wiley & Sons, Inc.10.1111/1754-9485.12336http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12336Radiation Oncology—Guidelinesn/an/aSummary

The uptake of stereotactic ablative body radiation therapy (SABR)/stereotactic body radiation therapy (SBRT) worldwide has been rapid. The Australian and New Zealand Faculty of Radiation Oncology (FRO) assembled an expert panel of radiation oncologists, radiation oncology medical physicists and radiation therapists to establish guidelines for safe practice of SABR. Draft guidelines were reviewed by a number of international experts in the field and then distributed through the membership of the FRO. Members of the Australian Institute of Radiography and the Australasian College of Physical Scientists and Engineers in Medicine were also asked to comment on the draft. Evidence-based recommendations (where applicable) address aspects of departmental staffing, procedures and equipment, quality assurance measures, as well as organisational considerations for delivery of SABR treatments. Central to the guidelines is a set of key recommendations for departments undertaking SABR. These guidelines were developed collaboratively to provide an educational guide and reference for radiation therapy service providers to ensure appropriate care of patients receiving SABR.

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The uptake of stereotactic ablative body radiation therapy (SABR)/stereotactic body radiation therapy (SBRT) worldwide has been rapid. The Australian and New Zealand Faculty of Radiation Oncology (FRO) assembled an expert panel of radiation oncologists, radiation oncology medical physicists and radiation therapists to establish guidelines for safe practice of SABR. Draft guidelines were reviewed by a number of international experts in the field and then distributed through the membership of the FRO. Members of the Australian Institute of Radiography and the Australasian College of Physical Scientists and Engineers in Medicine were also asked to comment on the draft. Evidence-based recommendations (where applicable) address aspects of departmental staffing, procedures and equipment, quality assurance measures, as well as organisational considerations for delivery of SABR treatments. Central to the guidelines is a set of key recommendations for departments undertaking SABR. These guidelines were developed collaboratively to provide an educational guide and reference for radiation therapy service providers to ensure appropriate care of patients receiving SABR.
Involved-field radiotherapy for patients with mantle cell lymphomahttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12335Involved-field radiotherapy for patients with mantle cell lymphomaKatherine E Neville, Alessandra Bisquera, Anne L Capp2015-06-26T04:26:47.203941-05:00doi:10.1111/1754-9485.12335John Wiley & Sons, Inc.10.1111/1754-9485.12335http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12335Radiation Oncology—Original Articlen/an/aAbstract

Introduction

Retrospective analysis was performed at a single institution to assess the responsiveness of mantle cell lymphoma (MCL) to involved-field radiotherapy (IFRT).

Methods

All patients treated with IFRT to at least one site of MCL between 1998 and 2012 were included. There were 25 patients who received radiotherapy to 60 disease sites. Primary endpoint was overall response rate (ORR) infield for the first site of MCL treated per patient. Predictors of ORR were analysed for the primary endpoint. Time to local progression (TLP) infield and progression-free survival were calculated from the start of the first treatment course. Analysis of all sites collectively was also undertaken. Survival analysis was conducted by the Kaplan–Meier method.

Results

ORR rate was 84% for the first site treated per patient. Complete response and partial response rates were 68% and 16% respectively. Median TLP following radiotherapy to the first site was not reached. Infield control rate was 91% at 12 months (95% confidence interval 69–97%). When analysis was performed on all 60 sites, ORR was 85%. Symptomatic improvement occurred after IFRT to 93% of all sites. Systemic progression outside the radiotherapy field was the predominant form of failure following IFRT.

Conclusion

Radiotherapy generally induced a clinical response at all levels of dose administered, ranging from 3 to 36 Gy. However, increased durability of local control was suggested with higher doses. Radiotherapy is an effective treatment for palliation of MCL with objective and symptomatic responses seen over a range of radiotherapy doses.

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Introduction
Retrospective analysis was performed at a single institution to assess the responsiveness of mantle cell lymphoma (MCL) to involved-field radiotherapy (IFRT).
Methods
All patients treated with IFRT to at least one site of MCL between 1998 and 2012 were included. There were 25 patients who received radiotherapy to 60 disease sites. Primary endpoint was overall response rate (ORR) infield for the first site of MCL treated per patient. Predictors of ORR were analysed for the primary endpoint. Time to local progression (TLP) infield and progression-free survival were calculated from the start of the first treatment course. Analysis of all sites collectively was also undertaken. Survival analysis was conducted by the Kaplan–Meier method.
Results
ORR rate was 84% for the first site treated per patient. Complete response and partial response rates were 68% and 16% respectively. Median TLP following radiotherapy to the first site was not reached. Infield control rate was 91% at 12 months (95% confidence interval 69–97%). When analysis was performed on all 60 sites, ORR was 85%. Symptomatic improvement occurred after IFRT to 93% of all sites. Systemic progression outside the radiotherapy field was the predominant form of failure following IFRT.
Conclusion
Radiotherapy generally induced a clinical response at all levels of dose administered, ranging from 3 to 36 Gy. However, increased durability of local control was suggested with higher doses. Radiotherapy is an effective treatment for palliation of MCL with objective and symptomatic responses seen over a range of radiotherapy doses.
Imaging evaluation of treated benign bone tumourshttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12329Imaging evaluation of treated benign bone tumoursMichael A Dobson, Douglas J McDonald, Daniel E Wessell, Michael V Friedman2015-06-24T21:26:16.424935-05:00doi:10.1111/1754-9485.12329John Wiley & Sons, Inc.10.1111/1754-9485.12329http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12329Medical Imaging—Pictorial Essayn/an/aSummary

A number of benign bone tumours can be treated with curettage and packing with either bone cement or graft. It is essential that the radiologist be familiar with both the normal and abnormal post-operative imaging appearance of these treated tumours. Through the use of numerous imaging examples, we aim to provide a pictorial review of the expected post-operative appearance of benign bone tumours treated with curettage and packing, as well as the imaging features of recurrence, the most common potential complication.

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A number of benign bone tumours can be treated with curettage and packing with either bone cement or graft. It is essential that the radiologist be familiar with both the normal and abnormal post-operative imaging appearance of these treated tumours. Through the use of numerous imaging examples, we aim to provide a pictorial review of the expected post-operative appearance of benign bone tumours treated with curettage and packing, as well as the imaging features of recurrence, the most common potential complication.
Radiographer technique: Does it contribute to the question of clip migration?http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12327Radiographer technique: Does it contribute to the question of clip migration?Carolyn R Madeley, Meredith Anita Kessell, Chris JD Madeley, Donna Blanche Taylor, Elizabeth Jane Wylie2015-06-24T21:26:03.566848-05:00doi:10.1111/1754-9485.12327John Wiley & Sons, Inc.10.1111/1754-9485.12327http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12327Medical Imaging—Original Articlen/an/aAbstract

Introduction

Marker clips are commonly deployed at the site of a percutaneous breast biopsy. Studies have shown that displacement of the clip from the site of deployment is not uncommon. The objective of this study was to determine how much ‘migration’ could be seen with fixed structures within the breast tissue across three consecutive annual screening examinations, and therefore attempt to quantify how much of the reported clip migration could be due to radiographer technique.

Methods

Large, easily identified benign calcifications were measured by two investigators across three consecutive cycles of screening mammography. The position of the calcifications on the two standard mammographic views was measured in two planes. Other variables recorded included breast size and density, compression force used, and location of the benign calcifications within the breast.

Results

In 38% of cases, benign breast calcifications showed a mimicked movement of >15 mm in at least one plane. This was greatest in large breasts, those where fibroglandular tissue occupied less than 50% of the breast volume, and in the upper outer quadrant of the breast where mimicked movement >10 mm was noted in up to 90% of the larger breasts.

Conclusion

Fixed immobile objects in the breast can appear to move a distance of >15 mm in up to 30% of cases. Clinically, some of what has previously been called marker ‘migration’ may be spurious and accounted for by differences in radiographic positioning techniques.

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Introduction
Marker clips are commonly deployed at the site of a percutaneous breast biopsy. Studies have shown that displacement of the clip from the site of deployment is not uncommon. The objective of this study was to determine how much ‘migration’ could be seen with fixed structures within the breast tissue across three consecutive annual screening examinations, and therefore attempt to quantify how much of the reported clip migration could be due to radiographer technique.
Methods
Large, easily identified benign calcifications were measured by two investigators across three consecutive cycles of screening mammography. The position of the calcifications on the two standard mammographic views was measured in two planes. Other variables recorded included breast size and density, compression force used, and location of the benign calcifications within the breast.
Results
In 38% of cases, benign breast calcifications showed a mimicked movement of >15 mm in at least one plane. This was greatest in large breasts, those where fibroglandular tissue occupied less than 50% of the breast volume, and in the upper outer quadrant of the breast where mimicked movement >10 mm was noted in up to 90% of the larger breasts.
Conclusion
Fixed immobile objects in the breast can appear to move a distance of >15 mm in up to 30% of cases. Clinically, some of what has previously been called marker ‘migration’ may be spurious and accounted for by differences in radiographic positioning techniques.
Ropivacaine and dexamethasone: a potentially dangerous combination for therapeutic pain injectionshttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12333Ropivacaine and dexamethasone: a potentially dangerous combination for therapeutic pain injectionsTrevor William Watkins, Simon Dupre, John Richard Coucher2015-06-15T05:02:42.654166-05:00doi:10.1111/1754-9485.12333John Wiley & Sons, Inc.10.1111/1754-9485.12333http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12333Medical Imaging—Original Articlen/an/aAbstract

Introduction

Targeted spinal steroid injections are effective in reducing back pain in selected patient populations and carry a small risk of significant adverse neurological outcomes. Recent recommendations are for the use of non-particulate steroid agents for all spinal injections to reduce the risk of neurovascular embolic adverse events. Many injections have used a combination of local anaesthetic agent with the steroid. At our institutions, we have recently observed interactions between ropivacaine and dexamethasone combinations ascribed to the incompatibility of the former with alkaline solutions, resulting in rapid crystallisation. This study has further investigated the combinations of commonly used local anaesthetic and steroid combinations to determine if such precipitation effects are more widespread.

Methods

The commonly used local anaesthetics (lignocaine, bupivacaine, ropivacaine) and the non-particulate steroid dexamethasone sodium phosphate combinations were evaluated macroscopically, microscopically, and pH values measured. Where crystallisation was observed the rate of precipitation and crystal size was measured. Contamination of ropivacaine with sodium bicarbonate solution was also evaluated. Particulate size of the particulate steroid agent betamethasone acetate was evaluated as a comparison.

Results

All mixtures of ropivacaine and the non-particulate dexamethasone sodium phosphate assessed demonstrated a pH-dependent crystallisation of the solution. No precipitation was demonstrated with the combinations of dexamethasone and lignocaine or bupivacaine. Contamination of ropivacaine with residual sodium bicarbonate in a drawing up needle following air clearing had a precipitation effect.

Conclusion

We describe the effect of crystallisation with the combination of ropivacaine and the non-particulate steroid, dexamethasone sodium phosphate, a mixture that has been used in the literature for targeted pain injections. As this may be considered a non-particulate steroid/anaesthetic injectate, this would potentially carry increased risk if inadvertent intravascular injection occurred during a targeted spinal injection, as has been described with particulate steroid agents. This is due to the elevated pH of dexamethasone and the incompatibility of ropivacaine with alkaline solutions.

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Introduction
Targeted spinal steroid injections are effective in reducing back pain in selected patient populations and carry a small risk of significant adverse neurological outcomes. Recent recommendations are for the use of non-particulate steroid agents for all spinal injections to reduce the risk of neurovascular embolic adverse events. Many injections have used a combination of local anaesthetic agent with the steroid. At our institutions, we have recently observed interactions between ropivacaine and dexamethasone combinations ascribed to the incompatibility of the former with alkaline solutions, resulting in rapid crystallisation. This study has further investigated the combinations of commonly used local anaesthetic and steroid combinations to determine if such precipitation effects are more widespread.
Methods
The commonly used local anaesthetics (lignocaine, bupivacaine, ropivacaine) and the non-particulate steroid dexamethasone sodium phosphate combinations were evaluated macroscopically, microscopically, and pH values measured. Where crystallisation was observed the rate of precipitation and crystal size was measured. Contamination of ropivacaine with sodium bicarbonate solution was also evaluated. Particulate size of the particulate steroid agent betamethasone acetate was evaluated as a comparison.
Results
All mixtures of ropivacaine and the non-particulate dexamethasone sodium phosphate assessed demonstrated a pH-dependent crystallisation of the solution. No precipitation was demonstrated with the combinations of dexamethasone and lignocaine or bupivacaine. Contamination of ropivacaine with residual sodium bicarbonate in a drawing up needle following air clearing had a precipitation effect.
Conclusion
We describe the effect of crystallisation with the combination of ropivacaine and the non-particulate steroid, dexamethasone sodium phosphate, a mixture that has been used in the literature for targeted pain injections. As this may be considered a non-particulate steroid/anaesthetic injectate, this would potentially carry increased risk if inadvertent intravascular injection occurred during a targeted spinal injection, as has been described with particulate steroid agents. This is due to the elevated pH of dexamethasone and the incompatibility of ropivacaine with alkaline solutions.
Percutaneous insertion of peritoneal dialysis catheters using ultrasound and fluoroscopic guidance: A single centre experience and review of literaturehttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12331Percutaneous insertion of peritoneal dialysis catheters using ultrasound and fluoroscopic guidance: A single centre experience and review of literatureDiederick W De Boo, Nigel Mott, Peter Tregaskis, Trung Quach, Solomon Menahem, Rowan G Walker, Jim Koukounaras2015-06-15T04:38:44.859065-05:00doi:10.1111/1754-9485.12331John Wiley & Sons, Inc.10.1111/1754-9485.12331http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12331Medical Imaging—Review Articlen/an/aSummary

Various methods of peritoneal dialysis (PD) catheter insertion are available. The purpose of this study was to evaluate a percutaneous insertion technique using ultrasound (US) and fluoroscopy performed under conscious sedation and as day case procedure. Data of 87 percutaneous inserted dialysis catheters were prospectively collected, including patients' age, gender, body mass index, history of previous abdominal surgery and cause of end stage renal failure. Length of hospital stay, early complications and time to first use were also recorded. Institutional review board approval was obtained. A 100% technical success rate was observed. Early complications included bleeding (n = 3), catheter dysfunction (n = 6), exit site infection (n = 1) and exit site leakage (n = 1). All cases of catheter dysfunction and one case of bleeding required surgical revision. Median time of follow-up was 18 months (range 3–35), and median time from insertion to first use was days 14 (1–47). Of the 82 patients who started dialysis, 20 (23%) ceased PD at some stage during follow-up. Most frequently encountered reasons include deteriorating patient cognitive or functional status (n = 5), successful transplant kidney (n = 4) and pleuro-peritoneal fistula (n = 4). Sixty-two (71%) PD catheter insertions were performed as day case. The remaining insertions were performed on patients already admitted to the hospital. Percutaneous insertion of dialysis catheter using US and fluoroscopy is not only safe but can be performed as day case procedure in most patients, even with a medical history of abdominal surgery and/or obesity.

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Various methods of peritoneal dialysis (PD) catheter insertion are available. The purpose of this study was to evaluate a percutaneous insertion technique using ultrasound (US) and fluoroscopy performed under conscious sedation and as day case procedure. Data of 87 percutaneous inserted dialysis catheters were prospectively collected, including patients' age, gender, body mass index, history of previous abdominal surgery and cause of end stage renal failure. Length of hospital stay, early complications and time to first use were also recorded. Institutional review board approval was obtained. A 100% technical success rate was observed. Early complications included bleeding (n = 3), catheter dysfunction (n = 6), exit site infection (n = 1) and exit site leakage (n = 1). All cases of catheter dysfunction and one case of bleeding required surgical revision. Median time of follow-up was 18 months (range 3–35), and median time from insertion to first use was days 14 (1–47). Of the 82 patients who started dialysis, 20 (23%) ceased PD at some stage during follow-up. Most frequently encountered reasons include deteriorating patient cognitive or functional status (n = 5), successful transplant kidney (n = 4) and pleuro-peritoneal fistula (n = 4). Sixty-two (71%) PD catheter insertions were performed as day case. The remaining insertions were performed on patients already admitted to the hospital. Percutaneous insertion of dialysis catheter using US and fluoroscopy is not only safe but can be performed as day case procedure in most patients, even with a medical history of abdominal surgery and/or obesity.
Would you bet on PET? Evaluation of the significance of positive PET scan results post-microwave ablation for non-small cell lung cancerhttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12330Would you bet on PET? Evaluation of the significance of positive PET scan results post-microwave ablation for non-small cell lung cancerSyed N Zaheer, Justin M Whitley, Paul A Thomas, Karin Steinke2015-06-04T04:05:54.378078-05:00doi:10.1111/1754-9485.12330John Wiley & Sons, Inc.10.1111/1754-9485.12330http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12330Medical Imaging—Pictorial Essayn/an/aSummary

Fluodeoxyglucose-positron emission tomography (FDG-PET) imaging is an acknowledged modality for the follow-up of solid tumours treated with thermal ablation, with persistent or new FDG uptake at the ablation site considered to be a reliable indicator of local recurrence. Several cases of proven false-positive FDG-PET scans are illustrated in this pictorial essay with uptake at the site of the ablated tumour, remote from the ablated lesion and in mediastinal and hilar lymph nodes. Positive FDG-PET scans post-thermal ablation of lung tumours therefore cannot always reliably predict local tumour recurrence or nodal spread. It is important to be familiar with FDG uptake patterns post-ablation and their significance. FDG-PET avid lesions post-ablation may require histological confirmation before further therapy is planned or management is changed.

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Fluodeoxyglucose-positron emission tomography (FDG-PET) imaging is an acknowledged modality for the follow-up of solid tumours treated with thermal ablation, with persistent or new FDG uptake at the ablation site considered to be a reliable indicator of local recurrence. Several cases of proven false-positive FDG-PET scans are illustrated in this pictorial essay with uptake at the site of the ablated tumour, remote from the ablated lesion and in mediastinal and hilar lymph nodes. Positive FDG-PET scans post-thermal ablation of lung tumours therefore cannot always reliably predict local tumour recurrence or nodal spread. It is important to be familiar with FDG uptake patterns post-ablation and their significance. FDG-PET avid lesions post-ablation may require histological confirmation before further therapy is planned or management is changed.
Four-dimensional computed tomography (4DCT): A review of the current status and applicationshttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12326Four-dimensional computed tomography (4DCT): A review of the current status and applicationsYune Kwong, Alexandra Olimpia Mel, Greg Wheeler, John M Troupis2015-06-03T05:03:53.728209-05:00doi:10.1111/1754-9485.12326John Wiley & Sons, Inc.10.1111/1754-9485.12326http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12326Medical Imaging—Review Articlen/an/aSummary

The applications of conventional computed tomography (CT) have been widely researched and implemented in clinical practice. A recent technological innovation in the field of CT is the emergence of four-dimensional computed tomography (4DCT), where a three-dimensional computed tomography volume containing a moving structure is imaged over a period of time, creating a dynamic volume data set. 4DCT has previously been mainly utilised in the setting of radiation therapy planning, but with the development of wide field of view CT, 4DCT has opened major avenues in the diagnostic arena. The aim of this study is to provide a comprehensive narrative review of the literature regarding the current clinical applications of 4DCT. The applications reviewed include both routine diagnostic usage as well as an appraisal of the current research literature. A systematic review of the studies related to 4DCT was conducted. The Medline database was searched using the MeSH subject heading ‘Four-Dimensional Computed Tomography’. After excluding non-human and non-English papers, 2598 articles were found. Further exclusion criteria were applied, including date range (since wide field of view CT was introduced in 2007), and exclusion of technical/engineering/physics papers. Further filtration of papers included identification of Review papers. This process yielded 67 papers. Of these, exclusion of papers not specifically discussing 4DCT (cone beam, 4D models) yielded 38 papers. As part of the review, the technique for 4DCT is described, with perspectives as to how it has evolved and its benefits in different clinical indications.

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The applications of conventional computed tomography (CT) have been widely researched and implemented in clinical practice. A recent technological innovation in the field of CT is the emergence of four-dimensional computed tomography (4DCT), where a three-dimensional computed tomography volume containing a moving structure is imaged over a period of time, creating a dynamic volume data set. 4DCT has previously been mainly utilised in the setting of radiation therapy planning, but with the development of wide field of view CT, 4DCT has opened major avenues in the diagnostic arena. The aim of this study is to provide a comprehensive narrative review of the literature regarding the current clinical applications of 4DCT. The applications reviewed include both routine diagnostic usage as well as an appraisal of the current research literature. A systematic review of the studies related to 4DCT was conducted. The Medline database was searched using the MeSH subject heading ‘Four-Dimensional Computed Tomography’. After excluding non-human and non-English papers, 2598 articles were found. Further exclusion criteria were applied, including date range (since wide field of view CT was introduced in 2007), and exclusion of technical/engineering/physics papers. Further filtration of papers included identification of Review papers. This process yielded 67 papers. Of these, exclusion of papers not specifically discussing 4DCT (cone beam, 4D models) yielded 38 papers. As part of the review, the technique for 4DCT is described, with perspectives as to how it has evolved and its benefits in different clinical indications.
Ga-68 octreotate PET/CT and Tc-99m heat-denatured red blood cell SPECT/CT imaging of an intrapancreatic accessory spleenhttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12319Ga-68 octreotate PET/CT and Tc-99m heat-denatured red blood cell SPECT/CT imaging of an intrapancreatic accessory spleenThomas W Barber, Andrew Dixon, Marty Smith, Kenneth S K Yap, Victor Kalff2015-06-03T05:01:44.824615-05:00doi:10.1111/1754-9485.12319John Wiley & Sons, Inc.10.1111/1754-9485.12319http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12319Medical Imaging—Case of the Monthn/an/aSummary

Intrapancreatic accessory spleens are relatively uncommon and can be difficult to distinguish from neuroendocrine tumours on CT, MRI and somatostatin receptor scintigraphy. We present the case of a 26-year-old woman with an incidentally diagnosed pancreatic lesion confirmed to be an intrapancreatic accessory spleen on Tc-99m heat-denatured red blood cell single photon emission computed tomography/CT.

Neurolymphomatosis (NL) is a rare presentation of lymphoma or leukemic infiltration of cranial or peripheral nerves. It is distinct from subarachnoid seeding of lymphoma as well as perineural tumour seen in epidural lymphoma. This rare condition has been reported mainly in oncology literature. Imaging features of solitary nerve involvement mimics, among others, peripheral nerve sheath tumours. We present the MRI and 18fluorodeoxyglucose positron emission tomography (18FDG-PET) features of three cases of NL. MRI demonstrated variable appearances: infiltrative mass displacing neural fascicles, diffuse thickening and enhancement, and thickening of individual neural fascicles. 18FDG-PET demonstrated avid uptake in all cases, two of which revealed skip lesions of the same nerve. The diagnosis of NL was confirmed by uncomplicated CT-guided biopsy of the affected sciatic nerve in one patient.

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Neurolymphomatosis (NL) is a rare presentation of lymphoma or leukemic infiltration of cranial or peripheral nerves. It is distinct from subarachnoid seeding of lymphoma as well as perineural tumour seen in epidural lymphoma. This rare condition has been reported mainly in oncology literature. Imaging features of solitary nerve involvement mimics, among others, peripheral nerve sheath tumours. We present the MRI and 18fluorodeoxyglucose positron emission tomography (18FDG-PET) features of three cases of NL. MRI demonstrated variable appearances: infiltrative mass displacing neural fascicles, diffuse thickening and enhancement, and thickening of individual neural fascicles. 18FDG-PET demonstrated avid uptake in all cases, two of which revealed skip lesions of the same nerve. The diagnosis of NL was confirmed by uncomplicated CT-guided biopsy of the affected sciatic nerve in one patient.
Agreement and mortality prediction in high-resolution CT of diffuse fibrotic lung diseasehttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12314Agreement and mortality prediction in high-resolution CT of diffuse fibrotic lung diseaseMiranda L. Siemienowicz, Samuel J. Kruger, Nicole S. L. Goh, Julie E. Dobson, Timothy D. Spelman, Robert P. J. Fabiny2015-05-12T03:45:51.291512-05:00doi:10.1111/1754-9485.12314John Wiley & Sons, Inc.10.1111/1754-9485.12314http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12314Medical Imaging—Original Articlen/an/aAbstract

Introduction

The prognosis of diffuse fibrotic lung disease (DFLD) is known to be variable, but there is a paucity of literature on prognostic markers independent of precise clinical diagnosis. This study aimed to assess the mortality prediction of three high-resolution computed tomography (HRCT) scores in a heterogeneous population of patients with DFLD. A large radiologist and physician reader group was used to determine agreement among readers of varying background in applying these scores.

Methods

Institutional review board approval was obtained. Informed consent was waived for this retrospective study. Eighty HRCTs in 68 patients with DFLD (35 men, mean age 72.9 years) were evaluated retrospectively by 18 readers. Readers included thoracic and general radiologists, respiratory physicians and radiology trainees. Features scored were honeycombing, extent of disease and traction bronchiectasis. Demographics, diagnosis and pulmonary function data were collected. Patients were categorised as having either idiopathic pulmonary fibrosis, fibrosis relating to connective tissue disease, ‘miscellaneous’ DFLD or ‘undefined’, where no single entity was felt entirely or confidently to explain the pulmonary disease. Agreement was assessed using the kappa statistic. Associations with mortality were analysed using the Cox marginal model.

Conclusions

The presence of honeycombing and a greater extent of fibrotic lung disease predict increased mortality independent of clinical diagnosis. Our large, mixed-expertise reader group shows moderate interobserver agreement, comparable with agreement values for these scores in the literature.

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Introduction
The prognosis of diffuse fibrotic lung disease (DFLD) is known to be variable, but there is a paucity of literature on prognostic markers independent of precise clinical diagnosis. This study aimed to assess the mortality prediction of three high-resolution computed tomography (HRCT) scores in a heterogeneous population of patients with DFLD. A large radiologist and physician reader group was used to determine agreement among readers of varying background in applying these scores.
Methods
Institutional review board approval was obtained. Informed consent was waived for this retrospective study. Eighty HRCTs in 68 patients with DFLD (35 men, mean age 72.9 years) were evaluated retrospectively by 18 readers. Readers included thoracic and general radiologists, respiratory physicians and radiology trainees. Features scored were honeycombing, extent of disease and traction bronchiectasis. Demographics, diagnosis and pulmonary function data were collected. Patients were categorised as having either idiopathic pulmonary fibrosis, fibrosis relating to connective tissue disease, ‘miscellaneous’ DFLD or ‘undefined’, where no single entity was felt entirely or confidently to explain the pulmonary disease. Agreement was assessed using the kappa statistic. Associations with mortality were analysed using the Cox marginal model.
Results
Agreement was better for honeycombing (kappa = 0.44) and disease extent (kappa = 0.47) than traction bronchiectasis (kappa = 0.24). Honeycombing presence (P < 0.0005) and disease extent >30% (P = 0.002) predicted increased mortality independent of clinical diagnosis. Traction bronchiectasis was non-predictive. Clinical diagnosis was not an independent predictor, but age was independently associated with mortality (P = 0.004). Pulmonary function data were only available for 43 patients, but in a limited subanalysis, the diffusion capacity of carbon monoxide was independently predictive of increased mortality (P = 0.005).
Conclusions
The presence of honeycombing and a greater extent of fibrotic lung disease predict increased mortality independent of clinical diagnosis. Our large, mixed-expertise reader group shows moderate interobserver agreement, comparable with agreement values for these scores in the literature.
Prostatosymphyseal fistula and osteomyelitis pubis following transurethral resection of the prostate: CT and MRI findingshttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12304Prostatosymphyseal fistula and osteomyelitis pubis following transurethral resection of the prostate: CT and MRI findingsBenjamin Plateau, Marc Ruivard, Pierre-François Montoriol2015-04-23T04:56:05.360281-05:00doi:10.1111/1754-9485.12304John Wiley & Sons, Inc.10.1111/1754-9485.12304http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12304Radiology—Case of the Monthn/an/aSummary

We present a very rare case of osteomyelitis pubis in a 75-year-old male patient due to a prostatosymphyseal fistula, which constituted a few weeks after trans-urethral resection of the prostate. The patient had a previous history of prostatic carcinoma treated by radiotherapy, which may have played a role in the development of the fistula. Computed tomography with excretory phase and magnetic resonance imaging were performed and enabled to make the final diagnosis.

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We present a very rare case of osteomyelitis pubis in a 75-year-old male patient due to a prostatosymphyseal fistula, which constituted a few weeks after trans-urethral resection of the prostate. The patient had a previous history of prostatic carcinoma treated by radiotherapy, which may have played a role in the development of the fistula. Computed tomography with excretory phase and magnetic resonance imaging were performed and enabled to make the final diagnosis.
Chronic portomesenteic venous thrombosis complicated by a high flow arteriovenous malformation presenting with gastrointestinal bleedinghttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12308Chronic portomesenteic venous thrombosis complicated by a high flow arteriovenous malformation presenting with gastrointestinal bleedingAdam N. Plotnik, Frank Hebroni, Justin McWilliams2015-04-14T03:07:35.83893-05:00doi:10.1111/1754-9485.12308John Wiley & Sons, Inc.10.1111/1754-9485.12308http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12308Radiology—Case of the Monthn/an/aSummary

Portomesenteric venous thrombosis is a rare but potentially life-threatening condition. The presenting symptoms of chronic portomesenteric venous thrombosis are often non-specific but may present with variceal bleeding. We present the first reported case of chronic portomesenteric venous thrombosis causing a high flow arteriovenous malformation that resulted in extensive gastrointestinal bleeding.

Introduction

The study aims to compare the positional and volumetric differences of tumour volumes based on the maximum intensity projection (MIP) of four-dimensional CT (4DCT) and 18F-fluorodexyglucose (18F-FDG) positron emission tomography CT (PET/CT) images for the primary tumour of non-small cell lung cancer (NSCLC).

Methods

Ten patients with NSCLC underwent 4DCT and 18F-FDG PET/CT scans of the thorax on the same day. Internal gross target volumes (IGTVs) of the primary tumours were contoured on the MIP images of 4DCT to generate IGTVMIP. Gross target volumes (GTVs) based on PET (GTVPET) were determined with nine different threshold methods using the auto-contouring function. The differences in the volume, position, matching index (MI) and degree of inclusion (DI) of the GTVPET and IGTVMIP were investigated.

Results

In volume terms, GTVPET2.0 and GTVPET20% approximated closely to IGTVMIP with mean volume ratio of 0.93 ± 0.45 and 1.06 ± 0.43, respectively. The best MI was between IGTVMIP and GTVPET20% (0.45 ± 0.23). The best DI of IGTVMIP in GTVPET was IGTVMIP in GTVPET20% (0.61 ± 0.26).

Conclusions

In 3D PET images, the GTVPET contoured by standardised uptake value (SUV) 2.0 or 20% of maximal SUV (SUVmax) approximate closely to the IGTVMIP in target size, while the spatial mismatch is apparent between them. Therefore, neither of them could replace IGTVMIP in spatial position and form. The advent of 4D PET/CT may improve the accuracy of contouring the perimeter for moving targets.

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Introduction
The study aims to compare the positional and volumetric differences of tumour volumes based on the maximum intensity projection (MIP) of four-dimensional CT (4DCT) and 18F-fluorodexyglucose (18F-FDG) positron emission tomography CT (PET/CT) images for the primary tumour of non-small cell lung cancer (NSCLC).
Methods
Ten patients with NSCLC underwent 4DCT and 18F-FDG PET/CT scans of the thorax on the same day. Internal gross target volumes (IGTVs) of the primary tumours were contoured on the MIP images of 4DCT to generate IGTVMIP. Gross target volumes (GTVs) based on PET (GTVPET) were determined with nine different threshold methods using the auto-contouring function. The differences in the volume, position, matching index (MI) and degree of inclusion (DI) of the GTVPET and IGTVMIP were investigated.
Results
In volume terms, GTVPET2.0 and GTVPET20% approximated closely to IGTVMIP with mean volume ratio of 0.93 ± 0.45 and 1.06 ± 0.43, respectively. The best MI was between IGTVMIP and GTVPET20% (0.45 ± 0.23). The best DI of IGTVMIP in GTVPET was IGTVMIP in GTVPET20% (0.61 ± 0.26).
Conclusions
In 3D PET images, the GTVPET contoured by standardised uptake value (SUV) 2.0 or 20% of maximal SUV (SUVmax) approximate closely to the IGTVMIP in target size, while the spatial mismatch is apparent between them. Therefore, neither of them could replace IGTVMIP in spatial position and form. The advent of 4D PET/CT may improve the accuracy of contouring the perimeter for moving targets.
Gout-mimicking sarcoma recurrence at a prosthesis bone interface remote from any jointhttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12290Gout-mimicking sarcoma recurrence at a prosthesis bone interface remote from any jointBamikole Busayo Kenneth Ogunwale, M Fernanda Amary, John Andrew Mcinnes Skinner, Ruth Amanda Rachel Green2015-02-11T07:17:01.426525-05:00doi:10.1111/1754-9485.12290John Wiley & Sons, Inc.10.1111/1754-9485.12290http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12290Radiology—Case Reportn/an/aSummary

Gout is known to occur in a variety of organs but most commonly presents as an inflammatory arthropathy. A few reported cases have documented its occurrence in prosthetic neo-joints or juxta-articular to this. We present the first reported case at a bone prosthesis interface remote from any joint and mimicking sarcoma recurrence because of its unusual location.

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Gout is known to occur in a variety of organs but most commonly presents as an inflammatory arthropathy. A few reported cases have documented its occurrence in prosthetic neo-joints or juxta-articular to this. We present the first reported case at a bone prosthesis interface remote from any joint and mimicking sarcoma recurrence because of its unusual location.
What the radiologist needs to know about Charcot foothttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12325What the radiologist needs to know about Charcot footMarcela Mautone, Parm Naidoo2015-06-03T05:02:47.772186-05:00doi:10.1111/1754-9485.12325John Wiley & Sons, Inc.10.1111/1754-9485.12325http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12325Medical Imaging—Review Article395402Summary

Charcot neuropathic osteoarthropathy (CN) is a progressive disease affecting the bones, joints and soft tissue of the foot and ankle, most commonly associated with diabetic neuropathy. Patients with diabetes complicated by CN have especially high morbidity, frequency of hospitalisation, and therefore, significant utilisation of expensive medical resources. The diagnosis of early CN can be challenging and is based on clinical presentation supported by various imaging modalities. Imaging is important for the detection of early CN and is useful in monitoring progression and complications of the disease. The later stages of CN are potentially devastating for individuals and present an increasing socioeconomic challenge for health systems. The astute radiologist, particularly in the context of a multidisciplinary team, plays a critical role in diagnosis of the primary disease and its complications. This review article aims to outline the key features of CN, emphasising current clinical and radiologic concepts as an aid for the practising radiologist.

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Charcot neuropathic osteoarthropathy (CN) is a progressive disease affecting the bones, joints and soft tissue of the foot and ankle, most commonly associated with diabetic neuropathy. Patients with diabetes complicated by CN have especially high morbidity, frequency of hospitalisation, and therefore, significant utilisation of expensive medical resources. The diagnosis of early CN can be challenging and is based on clinical presentation supported by various imaging modalities. Imaging is important for the detection of early CN and is useful in monitoring progression and complications of the disease. The later stages of CN are potentially devastating for individuals and present an increasing socioeconomic challenge for health systems. The astute radiologist, particularly in the context of a multidisciplinary team, plays a critical role in diagnosis of the primary disease and its complications. This review article aims to outline the key features of CN, emphasising current clinical and radiologic concepts as an aid for the practising radiologist.
Certain performance values arising from mammographic test set readings correlate well with clinical audithttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12301Certain performance values arising from mammographic test set readings correlate well with clinical auditBaoLin Pauline Soh, Warwick Bruce Lee, Claudia Mello-Thoms, Kriscia Tapia, John Ryan, Wai Tak Hung, Graham Thompson, Rob Heard, Patrick Brennan2015-04-01T02:15:04.177013-05:00doi:10.1111/1754-9485.12301John Wiley & Sons, Inc.10.1111/1754-9485.12301http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12301Medical Imaging—Original Article403410Abstract

Introduction

Test sets have been increasingly utilised to augment clinical audit in breast screening programmes; however, their relationship has never been satisfactorily understood. This study examined the relationship between mammographic test set performance and clinical audit data.

Methods

Clinical audit data over a 2-year period was generated for each of 20 radiologists. Sixty mammographic examinations, consisting of 40 normal and 20 cancer cases, formed the test set. Readers located any identifiable cancer, and levels of confidence were scored from 2 to 5, where a score of 3 and above is considered a recall rating. Jackknifing free response operating characteristic (JAFROC) figure-of-merit (FOM), location sensitivity and specificity were calculated for individual readers and then compared with clinical audit values using Spearman's rho.

Conclusion

Performance indicators from test set demonstrate significant correlations with specific aspects of clinical performance, although caution needs to be exercised when generalising test set specificity to the clinical situation.

Introduction

Approximately one-third of breast cancers are impalpable and require pre-operative image-guided localisation. Hook-wire localisation (HWL) is commonly used but has several disadvantages. Use of a low-activity radioactive iodine-125 seed is a promising alternative technique used in the USA and the Netherlands. This pilot study describes the first use of this in Australia.

Methods

In this prospective pilot study, 21 participants with biopsy-proven breast cancer underwent radioguided occult lesion localisation using iodine-125 seed(s) (ROLLIS) with insertion of a hook-wire for back up. Sentinel node biopsy was performed where indicated. Ease of hook-wire and seed insertion, duration of the procedure, dependence on the seed versus hook-wire during surgery, lesion location within the specimen, histopathology including size of radial margins, the ease of seed retrieval in pathology, and safe return of seeds for disposal were documented. Radiation dosimetry of staff was performed.

Results

All seeds were placed within 3.5 mm of the lesion. All lesions and seeds were removed. One participant needed re-excision for involved margins. Radiologists and surgeons both preferred ROLLIS. Surgeons were able to depend on the seed for localisation in all but one case. Sentinel node biopsy was successfully performed when required. Pathologists found seed retrieval quick and easy, with no detrimental effect on tissue processing. No radiation doses measurably above background were received by staff.

Conclusion

ROLLIS is an easily learnt, safe and effective alternative technique to standard HWL.

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Introduction
Approximately one-third of breast cancers are impalpable and require pre-operative image-guided localisation. Hook-wire localisation (HWL) is commonly used but has several disadvantages. Use of a low-activity radioactive iodine-125 seed is a promising alternative technique used in the USA and the Netherlands. This pilot study describes the first use of this in Australia.
Methods
In this prospective pilot study, 21 participants with biopsy-proven breast cancer underwent radioguided occult lesion localisation using iodine-125 seed(s) (ROLLIS) with insertion of a hook-wire for back up. Sentinel node biopsy was performed where indicated. Ease of hook-wire and seed insertion, duration of the procedure, dependence on the seed versus hook-wire during surgery, lesion location within the specimen, histopathology including size of radial margins, the ease of seed retrieval in pathology, and safe return of seeds for disposal were documented. Radiation dosimetry of staff was performed.
Results
All seeds were placed within 3.5 mm of the lesion. All lesions and seeds were removed. One participant needed re-excision for involved margins. Radiologists and surgeons both preferred ROLLIS. Surgeons were able to depend on the seed for localisation in all but one case. Sentinel node biopsy was successfully performed when required. Pathologists found seed retrieval quick and easy, with no detrimental effect on tissue processing. No radiation doses measurably above background were received by staff.
Conclusion
ROLLIS is an easily learnt, safe and effective alternative technique to standard HWL.
Optimising the imaging plane for right ventricular magnetic resonance volume analysis in adult patients referred for assessment of right ventricular structure and functionhttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12303Optimising the imaging plane for right ventricular magnetic resonance volume analysis in adult patients referred for assessment of right ventricular structure and functionStephen Lyen, Helen Mathias, Elisa McAlindon, Adam Trickey, Jonathan Rodrigues, Chiara Bucciarelli-Ducci, Mark Hamilton, Nathan Manghat2015-04-21T21:07:06.30119-05:00doi:10.1111/1754-9485.12303John Wiley & Sons, Inc.10.1111/1754-9485.12303http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12303Medical Imaging—Original Article421430Abstract

Introduction

Our aim was to evaluate the reproducibility and accuracy of using short-axis and axial (transaxial) plane for magnetic resonance imaging analysis in adult patients referred for assessment of right ventricular (RV) structure and function.

Methods

Twenty consecutive subjects (10 male, 10 female, mean age 32.2 ± 14.8 years) who were referred for RV assessment and had cardiac magnetic resonance imaging were retrospectively selected. Axial and short-axis manual contouring was performed using cine steady-state free precession sequences by three experienced imaging specialists. The reproducibility of end diastolic volumes, end systolic volumes and ejection fraction was assessed with intraclass correlation coefficients (ICCs) and paired t-tests. Left ventricular stroke volume (LVSV) and RV stroke volumes (RVSV) were compared with concordance correlation coefficients (CCCs) and t-tests to determine accuracy.

Results

The concordance between the RVSV and LVSV was good using both methods (axial RVSV CCC = 0.93, short-axis RVSV CCC = 0.86). Paired t-test and analysis of variance showed that the LV/RV stroke volume differences were not significant (p = 0.17). There was slight improvement in interobserver reliability with end systolic volume measurements (axial ICC = 0.92, short-axis ICC = 0.81) but this failed to reach statistical significance (p = 0.37). There was excellent intraobserver variability (ICC > 0.9).

Conclusion

This study shows that there is no statistically significant difference in reproducibility or accuracy using the short-axis or axial orientations in RV volume analysis in adult patients being referred for RV assessment.

Introduction

Magnetic resonance imaging (MRI) is useful for detecting joint inflammation and damage in the inflammatory arthropathies. This study aimed to investigate MRI cartilage damage and its associations with joint inflammation in patients with gout compared with a group with rheumatoid arthritis (RA).

Methods

Forty patients with gout and 38 with seropositive RA underwent 3T-MRI of the wrist with assessment of cartilage damage at six carpal sites, using established scoring systems. Synovitis and bone oedema (BME) were graded according to Rheumatoid Arthritis MRI Scoring System criteria. Cartilage damage was compared between the groups adjusting for synovitis and disease duration using logistic regression analysis.

Results

Compared with RA, there were fewer sites of cartilage damage and lower total damage scores in the gout group (P = 0.02 and 0.003), adjusting for their longer disease duration and lesser degree of synovitis. Cartilage damage was strongly associated with synovitis in both conditions (R = 0.59, P < 0.0001 and R = 0.52, P = 0.0045 respectively) and highly correlated with BME in RA (R = 0.69, P < 0.0001) but not in gout (R = 0.095, P = 0.56).

Conclusions

Cartilage damage is less severe in gout than in RA, with fewer sites affected and lower overall scores. It is associated with synovitis in both diseases, likely indicating an effect of pro-inflammatory cytokine production on cartilage integrity. However, the strong association between cartilage damage and BME observed in RA was not identified in gout. This emphasizes differences in the underlying pathophysiology of joint damage in these two conditions.

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Introduction
Magnetic resonance imaging (MRI) is useful for detecting joint inflammation and damage in the inflammatory arthropathies. This study aimed to investigate MRI cartilage damage and its associations with joint inflammation in patients with gout compared with a group with rheumatoid arthritis (RA).
Methods
Forty patients with gout and 38 with seropositive RA underwent 3T-MRI of the wrist with assessment of cartilage damage at six carpal sites, using established scoring systems. Synovitis and bone oedema (BME) were graded according to Rheumatoid Arthritis MRI Scoring System criteria. Cartilage damage was compared between the groups adjusting for synovitis and disease duration using logistic regression analysis.
Results
Compared with RA, there were fewer sites of cartilage damage and lower total damage scores in the gout group (P = 0.02 and 0.003), adjusting for their longer disease duration and lesser degree of synovitis. Cartilage damage was strongly associated with synovitis in both conditions (R = 0.59, P < 0.0001 and R = 0.52, P = 0.0045 respectively) and highly correlated with BME in RA (R = 0.69, P < 0.0001) but not in gout (R = 0.095, P = 0.56).
Conclusions
Cartilage damage is less severe in gout than in RA, with fewer sites affected and lower overall scores. It is associated with synovitis in both diseases, likely indicating an effect of pro-inflammatory cytokine production on cartilage integrity. However, the strong association between cartilage damage and BME observed in RA was not identified in gout. This emphasizes differences in the underlying pathophysiology of joint damage in these two conditions.
Chronic recurrent multifocal osteomyelitis: A rare entityhttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12311Chronic recurrent multifocal osteomyelitis: A rare entityGajan Surendra, Umesh Shetty2015-04-21T21:07:16.892536-05:00doi:10.1111/1754-9485.12311John Wiley & Sons, Inc.10.1111/1754-9485.12311http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12311Medical Imaging—Original Article436444Abstract

Introduction

Chronic recurrent multifocal osteomyelitis (CRMO) is an auto-inflammatory disease which is characterised by non-infectious bone lesions at multiple sites which have a relapsing nature. Our aim is to examine the role of radiology in diagnosis and management of CRMO patients who have been managed at the Mater Children's Hospital.

Methods

This is a retrospective analysis of patients who have been managed with CRMO at the Mater Hospital since 2002. Inclusion criteria included a final diagnosis of CRMO. Exclusion criteria were a diagnosis more likely than CRMO. Medical images for each patient were evaluated for lesion features, location of lesion, number of bony lesions and whether or not the radiographic appearance would be characteristic of CRMO.

Results

Initially, 17 patients were included in the study; however, seven patients were excluded due to a more likely alternative diagnosis. In total, 24 lesions were detected; the most common anatomical sites were the spine (25%), feet (25%), ribs (16.7%) and femur (12.5%). Plain radiography lacked sensitivity, but it was important in initial screening and evaluating progress of lesions. MRI is important for targeted investigation and further evaluation of lesions. Bone scintigraphy is useful for detecting other affected sites. Due to the exposure to radiation, computed tomography is generally avoided.

Conclusions

The combination of imaging modalities plays a large role in CRMO diagnosis. CRMO lesions usually appear ill defined with no pathognomonic features. The distribution of bony lesions can aid diagnosis, with lower limbs and clavicles commonly affected.

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Introduction
Chronic recurrent multifocal osteomyelitis (CRMO) is an auto-inflammatory disease which is characterised by non-infectious bone lesions at multiple sites which have a relapsing nature. Our aim is to examine the role of radiology in diagnosis and management of CRMO patients who have been managed at the Mater Children's Hospital.
Methods
This is a retrospective analysis of patients who have been managed with CRMO at the Mater Hospital since 2002. Inclusion criteria included a final diagnosis of CRMO. Exclusion criteria were a diagnosis more likely than CRMO. Medical images for each patient were evaluated for lesion features, location of lesion, number of bony lesions and whether or not the radiographic appearance would be characteristic of CRMO.
Results
Initially, 17 patients were included in the study; however, seven patients were excluded due to a more likely alternative diagnosis. In total, 24 lesions were detected; the most common anatomical sites were the spine (25%), feet (25%), ribs (16.7%) and femur (12.5%). Plain radiography lacked sensitivity, but it was important in initial screening and evaluating progress of lesions. MRI is important for targeted investigation and further evaluation of lesions. Bone scintigraphy is useful for detecting other affected sites. Due to the exposure to radiation, computed tomography is generally avoided.
Conclusions
The combination of imaging modalities plays a large role in CRMO diagnosis. CRMO lesions usually appear ill defined with no pathognomonic features. The distribution of bony lesions can aid diagnosis, with lower limbs and clavicles commonly affected.
FDG-PET/CT detection of very early breast cancer in women with breast microcalcification lesions found in mammography screeninghttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12309FDG-PET/CT detection of very early breast cancer in women with breast microcalcification lesions found in mammography screeningNan-Jing Peng, Chen-Pin Chou, Huay-Ben Pan, Tsung-Hsien Chang, Chin Hu, Yu-Li Chiu, Ting-Ying Fu, Hong-Tai Chang2015-04-14T03:07:46.767959-05:00doi:10.1111/1754-9485.12309John Wiley & Sons, Inc.10.1111/1754-9485.12309http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12309Medical Imaging—Original Article445452Abstract

Introduction

To assess the efficacy of positron emission tomography/computed tomography with the glucose analogue 2-[18F]fluoro-2-deoxy-D-glucose (FDG-PET/CT) in Taiwanese women with early breast cancer detected by mammography screening.

Methods

Dual-time-point imaging of whole-body supine and breast prone scans using FDG-PET/CT were performed sequentially in the pre-operative stage.

Conclusions

FDG-PET/CT with whole-body scanning demonstrated high sensitivity to invasive breast cancer, limited sensitivity to non-invasive breast cancer, and high specificity for breast cancer. FDG-PET/CT might be useful for differentiating tumour invasiveness. However, the good PPV but poor NPV do not allow the physician to discard the biopsy.

Intraventricular lesions of the central nervous system (CNS) can present a diagnostic challenge due to a range of differential diagnoses and radiological appearances. Both CT and MRI imaging findings, in combination with location and patient's age, can help limit the differentials. This pictorial essay presents the salient radiological features, location and demographics of the more common intraventricular lesions of the brain.

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Intraventricular lesions of the central nervous system (CNS) can present a diagnostic challenge due to a range of differential diagnoses and radiological appearances. Both CT and MRI imaging findings, in combination with location and patient's age, can help limit the differentials. This pictorial essay presents the salient radiological features, location and demographics of the more common intraventricular lesions of the brain.
Musculoskeletal desmoid tumours: Diagnostic imaging appearanceshttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12318Musculoskeletal desmoid tumours: Diagnostic imaging appearancesDaniel Liu, Warren Perera, Stephen Schlicht, Peter Choong, John Slavin, Marcus Pianta2015-05-13T20:53:08.728891-05:00doi:10.1111/1754-9485.12318John Wiley & Sons, Inc.10.1111/1754-9485.12318http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12318Medical Imaging—Pictorial Essay461467Summary

This study aimed to discuss the role medical imaging has on diagnosis of musculoskeletal desmoid tumours and to describe their radiological appearances on various imaging modalities. Imaging of histologically proven cases of desmoid tumours at St. Vincent's Hospital Melbourne were obtained via picture archiving communication system (PACS) and then assessed by two musculoskeletal radiologists. Suitable imagings were obtained from PACS. All imaging chosen was de-identified.

Desmoid tumours can occur in many areas of the body. Imaging plays an important role in the diagnosis of these tumours and magnetic resonance imaging has been the gold standard for imaging and is the most accurate in terms of assessing tumour margins and involvement of surrounding structures.

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This study aimed to discuss the role medical imaging has on diagnosis of musculoskeletal desmoid tumours and to describe their radiological appearances on various imaging modalities. Imaging of histologically proven cases of desmoid tumours at St. Vincent's Hospital Melbourne were obtained via picture archiving communication system (PACS) and then assessed by two musculoskeletal radiologists. Suitable imagings were obtained from PACS. All imaging chosen was de-identified.
Desmoid tumours can occur in many areas of the body. Imaging plays an important role in the diagnosis of these tumours and magnetic resonance imaging has been the gold standard for imaging and is the most accurate in terms of assessing tumour margins and involvement of surrounding structures.
Management of scrotal arteriovenous malformation with transcatheter embolisation coils and percutaneous sclerotherapy under angiographic guidancehttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12261Management of scrotal arteriovenous malformation with transcatheter embolisation coils and percutaneous sclerotherapy under angiographic guidanceWing Lung Alvin So, Joga Chaganti, Richard Waugh, Richard J Ferguson2014-12-10T04:40:19.747816-05:00doi:10.1111/1754-9485.12261John Wiley & Sons, Inc.10.1111/1754-9485.12261http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12261Medical Imaging—Case of the Month468470Summary

Arteriovenous malformations of the scrotum are infrequent and are usually treated by a combination of endovascular embolisation and surgery. We present a case of scrotal arteriovenous malformation treated effectively by a combination of endovascular and direct percutaneous techniques.

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Arteriovenous malformations of the scrotum are infrequent and are usually treated by a combination of endovascular embolisation and surgery. We present a case of scrotal arteriovenous malformation treated effectively by a combination of endovascular and direct percutaneous techniques.
Case report: Cavitation of mesenteric lymph nodes as the presenting feature of coeliac diseasehttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12274Case report: Cavitation of mesenteric lymph nodes as the presenting feature of coeliac diseaseCharlotte E Forrest, Vahid Masters, Caroline L Smith, Gelareh Farshid2015-01-15T04:36:40.593232-05:00doi:10.1111/1754-9485.12274John Wiley & Sons, Inc.10.1111/1754-9485.12274http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12274Medical Imaging—Case of the Month471473Summary

Cystic cavitation of the lymph nodes associated with hyposplenism is a rare and under-recognised complication of coeliac disease. This report encompasses the clinical, radiological and pathological features of this condition, while demonstrating the pivotal role radiological imaging plays in achieving a clinical diagnosis.

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Cystic cavitation of the lymph nodes associated with hyposplenism is a rare and under-recognised complication of coeliac disease. This report encompasses the clinical, radiological and pathological features of this condition, while demonstrating the pivotal role radiological imaging plays in achieving a clinical diagnosis.
When is an acoustic neuroma not an acoustic neuroma? Pitfalls for radiosurgeonshttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12328When is an acoustic neuroma not an acoustic neuroma? Pitfalls for radiosurgeonsDaniel E Roos, Sandy G Patel, Andrew E Potter, Andrew C Zacest2015-06-04T04:05:31.649833-05:00doi:10.1111/1754-9485.12328John Wiley & Sons, Inc.10.1111/1754-9485.12328http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12328Medical Imaging—Radiation Oncology—Original Article474479Abstract

Introduction

Because acoustic neuroma (AN), also termed vestibular schwannoma, constitutes by far the commonest intracranial schwannoma and cerebello-pontine angle (CPA) tumour, there is a risk of overlooking rarer alternative diagnoses with similar clinical and/or radiological features. The purpose of this article is to highlight to radiosurgeons the potentially serious implications of this problem through illustrative case studies.

Results

Between November 1993 and October 2014, we treated 132 patients referred with a clinical diagnosis of AN, the vast majority with 12 Gy marginal dose. Three of these (2.3%), evident either at the time of treatment (2) or subsequently (1), had features instead consistent with cochlear schwannoma, facial schwannoma and meningioma, respectively. Each warranted significant modification to standard AN outlining and fields. The meningioma progressed due to geographic miss. One other patient with recurrent facial schwannoma (not yet needing SRS) was also referred with an incorrect diagnosis of AN.

Conclusion

When rare variants of common medical problems are not identified before referral, there is a risk that ‘blinkering’ can lead to misdiagnosis and suboptimal treatment. Radiosurgeons need to be particularly mindful of this issue with AN, which can mimic several other tumours occurring in the CPA region, albeit with different patterns of spread. Optimal imaging, high-quality radiology reporting and neuroradiology input at the time of SRS planning within the setting of a specialised multidisciplinary team are highly desirable.

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Introduction
Because acoustic neuroma (AN), also termed vestibular schwannoma, constitutes by far the commonest intracranial schwannoma and cerebello-pontine angle (CPA) tumour, there is a risk of overlooking rarer alternative diagnoses with similar clinical and/or radiological features. The purpose of this article is to highlight to radiosurgeons the potentially serious implications of this problem through illustrative case studies.
Methods
Our linac stereotactic radiosurgery (SRS) technique has been previously described, with stereotactic headring fixation and treatment delivered via cones or micro-multileaf collimators using multiple arcs or static beams.
Results
Between November 1993 and October 2014, we treated 132 patients referred with a clinical diagnosis of AN, the vast majority with 12 Gy marginal dose. Three of these (2.3%), evident either at the time of treatment (2) or subsequently (1), had features instead consistent with cochlear schwannoma, facial schwannoma and meningioma, respectively. Each warranted significant modification to standard AN outlining and fields. The meningioma progressed due to geographic miss. One other patient with recurrent facial schwannoma (not yet needing SRS) was also referred with an incorrect diagnosis of AN.
Conclusion
When rare variants of common medical problems are not identified before referral, there is a risk that ‘blinkering’ can lead to misdiagnosis and suboptimal treatment. Radiosurgeons need to be particularly mindful of this issue with AN, which can mimic several other tumours occurring in the CPA region, albeit with different patterns of spread. Optimal imaging, high-quality radiology reporting and neuroradiology input at the time of SRS planning within the setting of a specialised multidisciplinary team are highly desirable.
Musculoskeletal desmoid tumours: Pre- and post-treatment radiological appearanceshttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12323Musculoskeletal desmoid tumours: Pre- and post-treatment radiological appearancesDaniel Liu, Warren Perera, Stephen Schlicht, Peter Choong, John Slavin, Marcus Pianta2015-06-10T20:51:50.091129-05:00doi:10.1111/1754-9485.12323John Wiley & Sons, Inc.10.1111/1754-9485.12323http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12323Medical Imaging—Radiation Oncology—Pictorial Essay480485Summary

This study was aimed to illustrate the pre- and post-treatment imaging findings of musculoskeletal desmoid tumours and describe current treatment methods. Imaging of histologically proven cases of desmoid tumours at St. Vincent's Hospital, Melbourne, were obtained via picture archiving communication system (PACS) and then assessed by two musculoskeletal radiologists. Suitable imaging both pre- and post-treatment were then obtained from PACS. All imaging chosen were de-identified. Ninety-two patients were found to have histologically proven cases of desmoid tumours between January 2000 and December 2013. Six patients with extra-abdominal tumours were selected, where pre- and post-treatment imaging was available. Desmoid tumours can occur in many areas of the body. Treatment of desmoids are varied. Although wide-margin surgery has been the traditional form of treatment, it still cannot guarantee absence of tumour recurrence despite microscopically tumour-free margins. Other forms of treatment such as non-steroidal anti-inflammatory drugs, radiotherapy, chemotherapy, tyrosine kinase inhibitors and also the conservative ‘watch and wait’ approach have been suggested, which show varying results.

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This study was aimed to illustrate the pre- and post-treatment imaging findings of musculoskeletal desmoid tumours and describe current treatment methods. Imaging of histologically proven cases of desmoid tumours at St. Vincent's Hospital, Melbourne, were obtained via picture archiving communication system (PACS) and then assessed by two musculoskeletal radiologists. Suitable imaging both pre- and post-treatment were then obtained from PACS. All imaging chosen were de-identified. Ninety-two patients were found to have histologically proven cases of desmoid tumours between January 2000 and December 2013. Six patients with extra-abdominal tumours were selected, where pre- and post-treatment imaging was available. Desmoid tumours can occur in many areas of the body. Treatment of desmoids are varied. Although wide-margin surgery has been the traditional form of treatment, it still cannot guarantee absence of tumour recurrence despite microscopically tumour-free margins. Other forms of treatment such as non-steroidal anti-inflammatory drugs, radiotherapy, chemotherapy, tyrosine kinase inhibitors and also the conservative ‘watch and wait’ approach have been suggested, which show varying results.
Differential kinetics of response and toxicity using stereotactic radiation and interventional radiological coiling for pulmonary arterio-venous shunting from metastatic leiomyosarcomahttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12307Differential kinetics of response and toxicity using stereotactic radiation and interventional radiological coiling for pulmonary arterio-venous shunting from metastatic leiomyosarcomaAnnie Ngai Man Wong, Shankar Siva, Renee Manser, Richard Dowling, Phillip Antippa, Kwang Chin, Linda Rose Mileshkin2015-04-23T04:57:10.395501-05:00doi:10.1111/1754-9485.12307John Wiley & Sons, Inc.10.1111/1754-9485.12307http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12307Medical Imaging—Radiation Oncology—Case of the Month486488Summary

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Case report demonstrating the differential kinetics of response and toxicity using stereotactic radiation and interventional radiological coiling for pulmonary arterio-venous shunting from leiomyosarcoma pulmonary metastases.
Interventions to facilitate recovering from job stress in an oncology setting: One size does not fit allhttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12340Interventions to facilitate recovering from job stress in an oncology setting: One size does not fit allAfaf Girgis2015-07-28T04:57:43.586062-05:00doi:10.1111/1754-9485.12340John Wiley & Sons, Inc.10.1111/1754-9485.12340http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12340Radiation Oncology—Editorial489490Evaluation of the effect of a 1-day interventional workshop on recovery from job stress for radiation therapists and oncology nurses: A randomised trialhttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12322Evaluation of the effect of a 1-day interventional workshop on recovery from job stress for radiation therapists and oncology nurses: A randomised trialAnne A. Poulsen, Christopher F Sharpley, Kathryn C Baumann, Julie Henderson, Michael G Poulsen2015-06-10T20:51:52.50809-05:00doi:10.1111/1754-9485.12322John Wiley & Sons, Inc.10.1111/1754-9485.12322http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12322Radiation Oncology—Original Article491498Abstract

Introduction

Cancer care workers experience high levels of occupational stress that can have adverse mental and physical health consequences. Educating health professionals about self-care practices throughout their careers can potentially build resilience. Our study aimed to evaluate the effects of an educational intervention to improve recovery from job stress, increase satisfaction with current self-care practices and improve sleep quality.

Methods

An equivalent, randomised comparison, pretest–post-test intervention design was used to investigate the effects of a 1-day workshop (plus educational material) compared with written educational material alone, on measures of recovery experiences (i.e. psychological detachment from work, relaxation, mastery experiences and control over leisure), satisfaction with recovery-related self-care practices and perceived sleep quality of 70 cancer care workers.

Results

Workshop participants reported greater mean changes 6 weeks post-workshop for total recovery experiences (F(1,69) = 8.145, P = .008), self-care satisfaction (F(1,69) = 8.277, P = .005) and perceived sleep quality (F(1,69) = 9.611, P = .003). There was a decline in the scores of the control group over the 6-week period for all measures. Workshop participants not only avoided this decline, but demonstrated increased mean scores, with a significant main effect 6 weeks post-workshop, compared with the control group (F(3,63) = 4.262, P = .008).

Conclusions

A 1-day intervention workshop improved recovery skills, satisfaction with self-care practices and perceived sleep quality of oncology nurses and radiation therapists. Outcomes were enhanced when participants actively participated in experiential group-based learning compared with receiving written material alone. This intervention has the potential to enhance resilience and prevent burnout at different points in a cancer worker's career.

Introduction

Visualisation of soft tissues such as pancreatic tumours by mega-voltage cone beam CT (MV-CBCT) is frequently difficult and daily localisation is often based on more easily seen adjacent bony anatomy. Fiducial markers implanted into pancreatic tumours serve as surrogates for tumour position and may more accurately represent absolute tumour position. Differences in daily shifts based on alignment to implanted fiducial markers vs. alignment to adjacent bony anatomy were compared.

Methods

Gold fiducial markers were placed into the pancreatic tumour under endoscopic ultrasound (EUS) guidance in 12 patients. Patients subsequently received image-guided intensity-modulated radiation therapy (IG-IMRT). MV-CBCT was performed prior to each fraction and isocentre shifts were performed based on alignment to the fiducial markers. We retrospectively reviewed archived MV-CBCT datasets and calculated shift differences in the left-right (LR), superior-inferior (SI) and anterior-posterior (AP) axes relative to shifts based on alignment to adjacent bony anatomy.

Conclusions

These data suggest that fiducial markers used in conjunction with MV-CBCT improve the accuracy of daily target delineation compared with localisation using adjacent bony anatomy and that gold fiducial markers using MV-CBCT alignment are a viable option for target localisation during IG-IMRT.

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Introduction
Visualisation of soft tissues such as pancreatic tumours by mega-voltage cone beam CT (MV-CBCT) is frequently difficult and daily localisation is often based on more easily seen adjacent bony anatomy. Fiducial markers implanted into pancreatic tumours serve as surrogates for tumour position and may more accurately represent absolute tumour position. Differences in daily shifts based on alignment to implanted fiducial markers vs. alignment to adjacent bony anatomy were compared.
Methods
Gold fiducial markers were placed into the pancreatic tumour under endoscopic ultrasound (EUS) guidance in 12 patients. Patients subsequently received image-guided intensity-modulated radiation therapy (IG-IMRT). MV-CBCT was performed prior to each fraction and isocentre shifts were performed based on alignment to the fiducial markers. We retrospectively reviewed archived MV-CBCT datasets and calculated shift differences in the left-right (LR), superior-inferior (SI) and anterior-posterior (AP) axes relative to shifts based on alignment to adjacent bony anatomy.
Results
Two hundred forty-three fractions were analysed. The mean absolute difference in isocentre shifts between the fiducial markers and those aligned to bony anatomy was 3.4 mm (range 0–13 mm), 6.3 mm (range 0–21 mm) and 2.6 mm (range 0–12 mm), in LR, SI and AP directions, respectively. The mean three-dimensional vector shift difference between markers vs. bony anatomy alignment was 8.6 mm.
Conclusions
These data suggest that fiducial markers used in conjunction with MV-CBCT improve the accuracy of daily target delineation compared with localisation using adjacent bony anatomy and that gold fiducial markers using MV-CBCT alignment are a viable option for target localisation during IG-IMRT.
Superior target volume and organ stability with the use of endorectal balloons in post-prostatectomy radiotherapyhttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12300Superior target volume and organ stability with the use of endorectal balloons in post-prostatectomy radiotherapyJeremiah F Leon, Michael G Jameson, Apsara Windsor, Kirrily Cloak, Sarah Keats, Philip Vial, Lois Holloway, Peter Metcalfe, Mark Sidhom2015-04-01T02:14:53.819328-05:00doi:10.1111/1754-9485.12300John Wiley & Sons, Inc.10.1111/1754-9485.12300http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12300Radiation Oncology—Original Article507513Abstract

Introduction

Methods

Seventy cone-beam CT (CBCT) obtained during radiotherapy treatment from seven patients treated with an ERB and 68 CBCT from seven patients treated without an ERB were contoured according to published guidelines. CTV was subdivided into superior and inferior CTV; whole rectal volume was subdivided into superior and inferior rectum and anal volume. Concordance index (CI) of CBCT treatment volumes compared with planning volumes was calculated and displacements were measured.

Introduction

The neutrophil-to-lymphocyte ratio (NLR) is an index of systemic inflammatory burden in malignancy. An elevated NLR has been associated with poor prognosis in a number of cancer sites. We investigated its role in a cohort of patients with locally advanced head and neck cancer.

Conclusion

In this cohort of locally advanced head and neck cancer patients treated with chemoradiotherapy, pre-treatment NLR ≥5 was prognostic for mortality. Further studies are required to confirm these results and to assess the interaction with other prognostic factors.

Introduction

Breath-holding (BH) technique is used for reducing the intrafraction-tumour motion in mobile lung tumours treated with radiotherapy (RT). There is paucity of literature evaluating differences in BH times in various phases of respiration in patients with lung cancer.

Methods

One hundred consecutive patients with lung cancer planned for radical RT/chemoradiation were accrued in the study. Eighty-seven patients were eligible for analysis at RT conclusion. Baseline pulmonary function test (PFT) were performed in all patients, and respiratory training was given from the day of RT planning. Deep inspiration breath hold (DIBH), deep expiration breath hold (DEBH) and mid-ventilation breath hold (MVBH) were recorded manually with a stopwatch for each patient at four time points (RT planning/baseline, RT starting, during RT and RT conclusion).

Results

Median DIBH times at RT planning, RT starting, during RT and RT conclusion were 21.2, 20.6, 20.1 and 21.1 s, respectively. The corresponding median DEBH and MVBH times were 16.3, 18.2, 18.3, 18.5 s and 19.9, 20.5, 21.3, 22.1 s, respectively. Respiratory training increased MVBH time at RT conclusion compared to baseline, which was statistically significant (19.9–22.1 s, P = 0.002). DIBH or DEBH times were stable at various time points with neither a significant improvement nor decline. Among various patient and tumour factors Forced Vital Capacity pre-bronchodilation (FVCpre) was the only factor that consistently predicted DIBH, DEBH and MVBH at all four time points with P value <0.05.

Conclusions

BH was well tolerated by most lung cancer patients with minimum median BH time of at least 16 s in any of the three phases of respiration. Respiratory training improved MVBH time while consistently maintaining DIBH and DEBH times throughout the course of radiotherapy.

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Introduction
Breath-holding (BH) technique is used for reducing the intrafraction-tumour motion in mobile lung tumours treated with radiotherapy (RT). There is paucity of literature evaluating differences in BH times in various phases of respiration in patients with lung cancer.
Methods
One hundred consecutive patients with lung cancer planned for radical RT/chemoradiation were accrued in the study. Eighty-seven patients were eligible for analysis at RT conclusion. Baseline pulmonary function test (PFT) were performed in all patients, and respiratory training was given from the day of RT planning. Deep inspiration breath hold (DIBH), deep expiration breath hold (DEBH) and mid-ventilation breath hold (MVBH) were recorded manually with a stopwatch for each patient at four time points (RT planning/baseline, RT starting, during RT and RT conclusion).
Results
Median DIBH times at RT planning, RT starting, during RT and RT conclusion were 21.2, 20.6, 20.1 and 21.1 s, respectively. The corresponding median DEBH and MVBH times were 16.3, 18.2, 18.3, 18.5 s and 19.9, 20.5, 21.3, 22.1 s, respectively. Respiratory training increased MVBH time at RT conclusion compared to baseline, which was statistically significant (19.9–22.1 s, P = 0.002). DIBH or DEBH times were stable at various time points with neither a significant improvement nor decline. Among various patient and tumour factors Forced Vital Capacity pre-bronchodilation (FVCpre) was the only factor that consistently predicted DIBH, DEBH and MVBH at all four time points with P value <0.05.
Conclusions
BH was well tolerated by most lung cancer patients with minimum median BH time of at least 16 s in any of the three phases of respiration. Respiratory training improved MVBH time while consistently maintaining DIBH and DEBH times throughout the course of radiotherapy.
Evaluating the accuracy of the XVI dual registration tool compared with manual soft tissue matching to localise tumour volumes for post-prostatectomy patients receiving radiotherapyhttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12332Evaluating the accuracy of the XVI dual registration tool compared with manual soft tissue matching to localise tumour volumes for post-prostatectomy patients receiving radiotherapyAmelia Campbell, Rebecca Owen, Elizabeth Brown, David Pryor, Anne Bernard, Margot Lehman2015-06-24T21:26:26.036298-05:00doi:10.1111/1754-9485.12332John Wiley & Sons, Inc.10.1111/1754-9485.12332http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12332Radiation Oncology—Original Article527534Abstract

Methods

Sixty CBCT images from ten post-prostatectomy patients were matched using: (i) the DRT and (ii) manual soft tissue registration by six radiation therapists (RTs). Shifts in the three Cartesian planes were recorded. The accuracy of the match was determined by comparing shifts to matches performed by two genitourinary radiation oncologists (ROs). A Bland–Altman method was used to assess the 95% levels of agreement (LoA). A clinical threshold of 3 mm was used to define equivalence between methods of matching.

Results

The 95% LoA between DRT-ROs in the superior/inferior, left/right and anterior/posterior directions were −2.21 to +3.18 mm, −0.77 to +0.84 mm, and −1.52 to +4.12 mm, respectively. The 95% LoA between RTs-ROs in the superior/inferior, left/right and anterior/posterior directions were −1.89 to +1.86 mm, −0.71 to +0.62 mm and −2.8 to +3.43 mm, respectively. Five DRT CBCT matches (8.33%) were outside the 3-mm threshold, all in the setting of bladder underfilling or rectal gas. The mean time for manual matching was 82 versus 65 s for DRT.

Conclusions

XVI's DRT is comparable with RTs manually matching soft tissue on CBCT. The DRT can minimise RT inter-observer variability; however, involuntary bladder and rectal filling can influence the tools accuracy, highlighting the need for RT evaluation of the DRT match.

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Introduction
Cone beam computerised tomography (CBCT) enables soft tissue visualisation to optimise matching in the post-prostatectomy setting, but is associated with inter-observer variability. This study assessed the accuracy and consistency of automated soft tissue localisation using XVI's dual registration tool (DRT).
Methods
Sixty CBCT images from ten post-prostatectomy patients were matched using: (i) the DRT and (ii) manual soft tissue registration by six radiation therapists (RTs). Shifts in the three Cartesian planes were recorded. The accuracy of the match was determined by comparing shifts to matches performed by two genitourinary radiation oncologists (ROs). A Bland–Altman method was used to assess the 95% levels of agreement (LoA). A clinical threshold of 3 mm was used to define equivalence between methods of matching.
Results
The 95% LoA between DRT-ROs in the superior/inferior, left/right and anterior/posterior directions were −2.21 to +3.18 mm, −0.77 to +0.84 mm, and −1.52 to +4.12 mm, respectively. The 95% LoA between RTs-ROs in the superior/inferior, left/right and anterior/posterior directions were −1.89 to +1.86 mm, −0.71 to +0.62 mm and −2.8 to +3.43 mm, respectively. Five DRT CBCT matches (8.33%) were outside the 3-mm threshold, all in the setting of bladder underfilling or rectal gas. The mean time for manual matching was 82 versus 65 s for DRT.
Conclusions
XVI's DRT is comparable with RTs manually matching soft tissue on CBCT. The DRT can minimise RT inter-observer variability; however, involuntary bladder and rectal filling can influence the tools accuracy, highlighting the need for RT evaluation of the DRT match.
Barriers to radiotherapy utilisation in New South Wales Australia: Health professionals' perceptions of impacting factorshttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12334Barriers to radiotherapy utilisation in New South Wales Australia: Health professionals' perceptions of impacting factorsPuma Sundaresan, Madeleine T King, Martin R Stockler, Daniel SJ Costa, Christopher G Milross2015-06-15T04:39:26.702406-05:00doi:10.1111/1754-9485.12334John Wiley & Sons, Inc.10.1111/1754-9485.12334http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12334Radiation Oncology—Original Article535541Abstract

Introduction

Utilisation of radiation therapy (RT) in Australia is below recommended evidence-based benchmarks. Barriers to the referral of patients for RT and the uptake of RT by patients may be affecting RT utilisation. The current study aimed to examine health professionals' (HPs) perceptions of potential barriers to RT referral and uptake.

Methods

A custom survey was developed to assess perceptions regarding the degree to which a range of issues affect decisions regarding RT. Hard copy surveys were disseminated to HPs involved in the care of cancer patients across New South Wales (NSW): medical, radiation and surgical oncologists, physicians (including palliative care), and general practitioners with an interest in oncology. Electronic versions of the survey were disseminated via oncology multidisciplinary teams and professional networks at participating hospitals.

Results

Two hundred fifty-three HPs participated via hard copy (n = 208) or electronic (n = 45) surveys. Two-thirds of HPs perceived acute side effects of RT, their management and impact on daily commitments, as well as fear and anxiety about RT, to exert moderate to significant influence on RT decisions. Treatment-related travel, need for accommodation and relocation were also perceived by 64% of HPs to do the same. Over half of HPs rated concern regarding late effects of RT, disruption to family and work life, and the ability to organise family and work commitments around RT, as moderate to significant influences on RT uptake.

Conclusion

Perceptions of HPs in NSW reveal potential important influencers of RT decisions by patients and clinicians. An understanding of these additional issues and their actual impact on RT-related decisions may inform future interventions to improve RT access and utilisation.

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Introduction
Utilisation of radiation therapy (RT) in Australia is below recommended evidence-based benchmarks. Barriers to the referral of patients for RT and the uptake of RT by patients may be affecting RT utilisation. The current study aimed to examine health professionals' (HPs) perceptions of potential barriers to RT referral and uptake.
Methods
A custom survey was developed to assess perceptions regarding the degree to which a range of issues affect decisions regarding RT. Hard copy surveys were disseminated to HPs involved in the care of cancer patients across New South Wales (NSW): medical, radiation and surgical oncologists, physicians (including palliative care), and general practitioners with an interest in oncology. Electronic versions of the survey were disseminated via oncology multidisciplinary teams and professional networks at participating hospitals.
Results
Two hundred fifty-three HPs participated via hard copy (n = 208) or electronic (n = 45) surveys. Two-thirds of HPs perceived acute side effects of RT, their management and impact on daily commitments, as well as fear and anxiety about RT, to exert moderate to significant influence on RT decisions. Treatment-related travel, need for accommodation and relocation were also perceived by 64% of HPs to do the same. Over half of HPs rated concern regarding late effects of RT, disruption to family and work life, and the ability to organise family and work commitments around RT, as moderate to significant influences on RT uptake.
Conclusion
Perceptions of HPs in NSW reveal potential important influencers of RT decisions by patients and clinicians. An understanding of these additional issues and their actual impact on RT-related decisions may inform future interventions to improve RT access and utilisation.
Continuing Professional Developmenthttp://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12246Continuing Professional Development2015-07-28T04:57:39.568122-05:00doi:10.1111/1754-9485.12246John Wiley & Sons, Inc.10.1111/1754-9485.12246http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2F1754-9485.12246CONTINUING PROFESSIONAL DEVELOPMENT542544